A Diabetics Best Friend

Guide dogs, watch dogs, hearing dogs, mobility assist dogs,  lap dogs, big dogs, small dogs – SRxA’s Word on Health readily admits to a fondness for them all.

So it’s hardly surprising that we were drawn to a story about Early Alert Canines, a non-profit group in California that is training man’s best friend to detect the subtle scents of low blood sugars and matching them with Type 1 diabetics.

These diabetic alert dogs are trained to recognize the biochemical scent that a diabetic’s body gives off as his or her blood glucose begins to change. The dogs learn that this biochemical scent is a command to the dogs for them to carry out an “alert” action – an early warning that can help their human partners avoid acutely dangerous hypoglycemia, and hyperglycemia.

Because hypoglycemia (low blood sugar) can cause severe problems including coma and death, and because hyperglycemia can contribute to long-term diabetes complications, these early warnings, allow diabetics to check their blood glucose levels and treat themselves appropriately. Thus, these amazing dogs are a not only a diabetic’s best friend, they also become life-changers and life-savers.

Although medical technology makes it possible for diabetics to regularly their own blood sugar levels, there are many times when such checks are problematic or even impossible; during sleep or during intense exercise, school work, or business meetings. Early Alert Canines, on the other hand, are always on alert for their insulin-dependent partners, ready to warn them about critical changes in their blood sugar levels.

We can’t smell it … It gets down to a molecular level,” says organization executive director Carol Edwards, noting the detection of a “cocktail of chemicals,” such as acetone, adrenaline and endorphins, which are released into the bloodstream as a diabetic’s glucose is dropping.

One person benefitting from the program is Nancy Harrison from California. Over a period of 17 years, paramedics have been dispatched on numerous occasions to revive her during hypoglycemic episodes. Instead of being woken by strangers in blue, wielding an IV and bag of dextrose 50%, when her glucose level starts to plummet.
she now finds an 80-pound yellow Labrador on her chest, alerting her the fact.
He gets in my face … he’ll plow me down to get me to pay attention to him,” says Harrison, about her dog Kade.

Trained initially by Guide Dogs for the Blind, Kade preferred to eat paper towels, socks and dryer sheets making him unsuitable for the sight-impaired. But when it comes to alerting Harrison, he is all business. When he  commutes with her to work he will put his head on her shoulder and start licking her face if her blood sugar starts to drop.

Early Alert Canines (EAC) trains two main classes of diabetic alert dogs: full-access service dogs and skilled companion dogs.

Full Access Service Dogs are trained and placed with diabetic adults and children age 12 and older. These dogs are fully trained diabetic alert dogs and attend work, school, extracurricular activities, errands, etc., with their diabetic partners. These dogs are accredited service dogs and can legally accompany their diabetic partners anywhere the general public is allowed. Full Access Service Dogs are perfect for people who can commit to having a dog with them all hours of the day.

Skilled Companion Alert Dogs are trained and placed with diabetic children, families with multiple diabetics, and some adults who find a service dog won’t fit into their lifestyle. Skilled Companion Alert Dogs are fully trained in hypoglycemic alerting, and do most of their work in the diabetic’s home, but do not have public access rights.

In order to qualify for the program potential dog owners must be insulin-dependent diabetes who have been using insulin for at least one year and diligently manage their diabetes. EAC is keen to point out that their dogs are not for people who are not attempting to closely control their diabetes. The application process involves an online application, paper applications, a phone interview, a home visit and orientation. There is an application fee of $100.

If approved, the diabetic attends Team Training, during which the diabetic may be matched up with a dog that the staff determines to be a good fit for the individual’s needs. Diabetics seeking placement with a skilled companion attend a one-week course, and diabetics seeking full access service dogs attend a two-week course.

For more information about these very special dogs and the Early Alert Canine program click here.

Inhaled Insulin as effective as Injected Insulin

Diabetes, affects 26.8 million people in the U.S. It is characterized by the body’s inability to properly regulate  blood sugar levels. Insulin, a hormone produced by the pancreas, normally regulates the body’s glucose levels, but in people with diabetes insufficient levels of insulin are produced or the body fails to respond adequately to the insulin it produces.

Current mealtime insulin therapy has a number of limitations, including the risk of severe hypoglycemia (low blood sugar), weight gain, inadequate post-meal glucose control, the need for complex titration of insulin doses in connection with meals and, of course, the need for injections.

So Word on Health was excited to hear that needles may soon become a thing of the past.  According to the manufacturer, investigational inhaled insulin works at least as well in patients with Type 1 diabetes as standard injection therapy.

MannKind Corporation announced yesterday that a new Phase III clinical trial showed that the ultra fast-acting inhaled insulin AFREZZA (insulin human [rDNA origin]) combined with basal insulin worked at least as well as injectable Humalog (insulin lispro [rDNA origin]).  Additionally, patients receiving the inhaled insulin showed lower rates of hypoglycemia, lower fasting and post-prandial blood glucose levels than those receiving subcutaneous injections

Effectively controlling blood sugar levels and managing hypoglycemic events go hand in hand as key to successfully treating patients with Type 1 diabetes,” said Satish K. Garg, M.D., Professor, Departments of Pediatrics and Medicine, University of Colorado School of Medicine; Head, Young Adult Diabetes Clinic, Barbara Davis Center for Childhood Diabetes, and lead study investigator.   “Our findings demonstrate that AFREZZA may offer a significant advance from current mealtime insulin delivery methods, as it is comparable to the standard of care in glycemic control and provides the additional benefit of lower hypoglycemia rates.”

AFREZZATM is a drug-device combination product, consisting of Inhalation Powder and a small, easy- to-use inhaler. Administered at the start of a meal, AFREZZA dissolves immediately upon inhalation and delivers insulin quickly to the blood stream. Peak insulin levels are achieved within 12 to 14 minutes of administration, mimicking the release of meal-time insulin observed in healthy individuals. To date, the AFREZZA clinical program has involved more than 50 different studies and over 5,000 adult patients with both Type 1 and Type 2 diabetes.

MannKind is currently preparing its FDA resubmission of the AFREZZA new drug application and is hoping to gain approval for the treatment of adults with Type 1 or Type 2 diabetes.